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Generic Name: lithium (LITH ee um)
Brand Names: Eskalith, Lithobid, Lithonate, Lithotabs, Eskalith-CR

What is lithium?

Lithium affects the flow of sodium through nerve and muscle cells in the body. Sodium affects excitation or mania.

Lithium is used to treat the manic episodes of bipolar disorder. Symptoms include hyperactivity, rushed speech, poor judgment, reduced need for sleep, aggression, and anger. Lithium also helps to prevent or lessen the intensity of manic episodes.

Lithium may also be used for purposes not listed in this medication guide.

Important information

Do not use lithium without telling your doctor if you are pregnant. It could cause harm to the unborn baby. Use an effective form of birth control, and tell your doctor if you become pregnant during treatment. Call your doctor at once if you have any early signs of lithium toxicity, such as nausea, vomiting, diarrhea, drowsiness, muscle weakness, tremor, lack of coordination, blurred vision, or ringing in your ears. Do not crush, chew, or break an extended-release tablet. Swallow the pill whole. Drink extra fluids to keep from getting dehydrated while you are taking this medication. Tell your doctor if you have been sweating excessively, or if you are sick with fever, vomiting, or diarrhea.

Avoid becoming overheated or dehydrated during exercise and in hot weather. Follow your doctor's instructions about the type and amount of liquids you should drink. In some cases, drinking too much liquid can be as unsafe as not drinking enough.

Lithium can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Before taking this medicine

You should not use lithium if you are allergic to it.

To make sure lithium is safe for you, tell your doctor if you have:

  • a history of abnormal electrocardiograph or ECG (sometimes called an EKG);

  • a history of fainting spells;

  • a family history of death before age 45;

  • kidney disease;

  • heart disease;

  • a debilitating illness;

  • a thyroid disorder;

  • low levels of sodium in your blood; or

  • if you are dehydrated.

It is not known whether lithium will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.

Lithium can pass into breast milk and may harm a nursing baby. You should not breast-feed while using this medicine.

Lithium is not approved for use by anyone younger than 12 years old.

How should I take lithium?

Take lithium exactly as it was prescribed for you. Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not use this medicine in larger or smaller amounts or for longer than recommended.

Do not crush, chew, or break an extended-release lithium tablet. Swallow the tablet whole.

Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.

Taking lithium can make it easier for you to become dehydrated, especially if you have any vomiting or diarrhea, if you are outdoors in the sun, or if you exercise vigorously or sweat more than usual. Dehydration can increase some of the side effects of lithium.

Call your doctor if you have are sick with a fever and vomiting or diarrhea, or if you are sweating more than usual. You can easily become dehydrated while taking lithium, which may affect your dose needs. Do not change your dose or medication schedule without your doctor's advice.

Drink extra fluids each day to prevent dehydration.

It may take up to 3 weeks before your symptoms improve. Keep using the medication as directed and tell your doctor if your symptoms do not begin to improve after 1 week of treatment.

If you need surgery, tell the surgeon ahead of time that you are using lithium.

While using lithium, you may need frequent blood tests.

Store at room temperature away from moisture and heat. Keep the bottle tightly closed when not in use.

Lithium dosing information

Usual Adult Dose of Lithium for Mania:

Acute Control:
-Usual dose: 1800 mg/day
-Extended release formulations: 900 mg orally in the morning and at nighttime
-Regular release formulations: 600 mg orally 3 times a day, in the morning, afternoon, and nighttime

Long-term Control:
-Maintenance dose: 900 to 1200 mg/day
-Extended release formulations: 600 mg orally in the morning and at nighttime
-Regular release formulations: 300 mg orally 3 to 4 times a day

Comments:
-Dosing must be individualized according to serum levels and the response to treatment.
-Alternative extended release formulation doses are 600 mg 3 times a day (acute control) and 300 mg 3 to 4 times a day (long-term control).

Uses:
-Treatment of manic episodes of bipolar disorder
-Maintenance treatment for individuals with bipolar disorder

Usual Adult Dose of Lithium for Bipolar Disorder:

Acute Control:
-Usual dose: 1800 mg/day
-Extended release formulations: 900 mg orally in the morning and at nighttime
-Regular release formulations: 600 mg orally 3 times a day, in the morning, afternoon, and nighttime

Long-term Control:
-Maintenance dose: 900 to 1200 mg/day
-Extended release formulations: 600 mg orally in the morning and at nighttime
-Regular release formulations: 300 mg orally 3 to 4 times a day

Comments:
-Dosing must be individualized according to serum levels and the response to treatment.
-Alternative extended release formulation doses are 600 mg 3 times a day (acute control) and 300 mg 3 to 4 times a day (long-term control).

Uses:
-Treatment of manic episodes of bipolar disorder
-Maintenance treatment for individuals with bipolar disorder

Usual Pediatric Dose of Lithium for Mania:

12 years and older:
Acute Control:
-Usual dose: 1800 mg/day
-Extended release formulations: 900 mg orally in the morning and at nighttime
-Regular release formulations: 600 mg orally 3 times a day, in the morning, afternoon, and nighttime

Long-term Control:
-Maintenance dose: 900 to 1200 mg/day
-Extended release formulations: 600 mg orally in the morning and at nighttime
-Regular release formulations: 300 mg orally 3 to 4 times a day

Comments:
-Dosing must be individualized according to serum levels and the response to treatment.
-Alternative extended release formulation doses are 600 mg 3 times a day (acute control) and 300 mg 3 to 4 times a day (long-term control).
-Maintenance therapy reduces the frequency of manic episodes and diminishes the intensity of the episodes.

Uses:
-Treatment of manic episodes of bipolar disorder
-Maintenance treatment for individuals with bipolar disorder

Usual Pediatric Dose of Lithium for Bipolar Disorder:

12 years and older:
Acute Control:
-Usual dose: 1800 mg/day
-Extended release formulations: 900 mg orally in the morning and at nighttime
-Regular release formulations: 600 mg orally 3 times a day, in the morning, afternoon, and nighttime

Long-term Control:
-Maintenance dose: 900 to 1200 mg/day
-Extended release formulations: 600 mg orally in the morning and at nighttime
-Regular release formulations: 300 mg orally 3 to 4 times a day

Comments:
-Dosing must be individualized according to serum levels and the response to treatment.
-Alternative extended release formulation doses are 600 mg 3 times a day (acute control) and 300 mg 3 to 4 times a day (long-term control).
-Maintenance therapy reduces the frequency of manic episodes and diminishes the intensity of the episodes.

Uses:
-Treatment of manic episodes of bipolar disorder
-Maintenance treatment for individuals with bipolar disorder

See also: Dosage Information (in more detail)

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Stop taking lithium and seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while taking lithium?

Lithium can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Avoid becoming overheated or dehydrated during exercise, in hot weather, or by not drinking enough fluids. Follow your doctor's instructions about the type and amount of liquids you should drink. In some cases, drinking too much liquid can be as unsafe as not drinking enough.

Do not change the amount of salt you consume in your diet. Changing your salt intake could change the amount of lithium in your blood.

Lithium side effects

Get emergency medical help if you have signs of an allergic reaction to lithium: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • a light-headed feeling, like you might pass out;

  • shortness of breath;

  • pounding heartbeats or fluttering in your chest;

  • increased urination;

  • weakness, dizziness or spinning sensation;

  • confusion, memory problems, hallucinations;

  • fever;

  • muscle stiffness, slurred speech;

  • uncontrolled muscle movements in your face (chewing, lip smacking, frowning, tongue movement, blinking or eye movement);

  • loss of bowel or bladder control;

  • a seizure (blackout or convulsions);

  • early signs of lithium toxicity - vomiting, diarrhea, tremors, loss of balance or coordination, drowsiness or muscle weakness;

  • dehydration symptoms - feeling very thirsty or hot, being unable to urinate, heavy sweating, or hot and dry skin; or

  • increased pressure inside the skull - severe headaches, ringing in your ears, dizziness, nausea, vision problems, pain behind your eyes.

Common lithium side effects may include:

  • drowsiness;

  • tremors in your hands;

  • dry mouth, increased thirst or urination;

  • nausea, vomiting, loss of appetite, stomach pain;

  • changes in your skin or hair;

  • cold feeling or discoloration in your fingers or toes;

  • feeling uneasy; or

  • impotence, loss of interest in sex.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

What other drugs will affect lithium?

Many drugs can interact with lithium. Not all possible interactions are listed here. Tell your doctor about all your current medicines and any you start or stop using, especially:

  • carbamazepine;

  • a diuretic or "water pill";

  • fluoxetine (Prozac);

  • metronidazole;

  • potassium iodide thyroid medication;

  • heart or blood pressure medication - benazepril, candesartan, captopril, diltiazem, enalapril, lisinopril, losartan, olmesartan, telmisartan, valsartan, verapamil, and others; or

  • NSAIDs (nonsteroidal anti-inflammatory drugs) - aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others.

This list is not complete and many other drugs can interact with lithium. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Give a list of all your medicines to any healthcare provider who treats you.

Where can I get more information?

  • Your pharmacist can provide more information about lithium.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use lithium only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date, and complete, but no guarantee is made to that effect. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2016 Cerner Multum, Inc. Version: 3.01. Revision Date: 2016-07-08, 11:00:04 AM.

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